In a research article published in PLOS Medicine, Huaidong Du of the University of Oxford, Oxford, United Kingdom and colleagues report that greater consumption of fresh fruit was associated with a lower incidence of diabetes, as well as reduced occurrence of complications in people with diabetes, in a Chinese population.

Although the health benefits of diets including fresh fruit and vegetables are well established, the sugar content of fruit has led to uncertainty about associated risks of diabetes and of vascular complications of the disease. Du and colleagues studied nearly 500,000 people participating in the China Kadoorie Biobank over about 7 years of follow-up, documenting new cases of diabetes and recording the occurrence of vascular disease and death in people with pre-existing diabetes.

The researchers found that people who reported elevated consumption of fresh fruit had a lower associated risk of developing diabetes in comparison with other participants (adjusted hazard ratio [aHR] 0.88, 95% CI 0.83-0.93), which corresponds to an estimated 0.2% reduction in the absolute risk of diabetes over 5 years. In people with diabetes, higher consumption of fresh fruit was associated with a lower risk of mortality (aHR 0.83, 95% CI 0.74-0.93 per 100g fruit/d), corresponding to an absolute decrease in risk of 1.9% at 5 years, and with lower risks of microvascular and macrovascular complications.

In addition to the health benefits of consuming fresh fruit, Du and colleagues emphasize the value of their findings for Asian populations where fruit consumption is commonly restricted in people with diabetes. The main limitation of this observational study is that the effects of fruit consumption can be difficult to distinguish from those of participants' other dietary and behavioural characteristics.

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Research Article

Funding:

The baseline survey and the first resurvey were supported by a research grant from Kadoorie Charitable Foundation, Hong Kong, China. The long-term continuation of the project is supported by program grants from the UK Wellcome Trust (088158/Z/09/Z, 104085/Z/14/Z, and 202922/Z/16/Z http://www.wellcome.ac.uk/); the Chinese Ministry of Science and Technology (2011BAI09B01, 2012-2014); and Chinese National Natural Science Foundation (81390540, 81390541, and 81390544 http://www.nsfc.gov.cn). The British Heart Foundation (https://www.bhf.org.uk), UK Medical Research Council (http://www.mrc.ac.uk) and Cancer Research UK (http://www.cancerresearchuk.org) provided core funding to the CTSU, University of Oxford. Fiona Bragg acknowledges support from the BHF Centre of Research Excellence, Oxford. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

RC is a member of the Editorial Board of PLOS Medicine. The authors declare that no other competing interests exist.

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